2014 News

“By doing my job I am taking the clinic to the community”-Philippi-based Community Care Worker

The July strikes and subsequent arrest of community health workers in the Free State have focused attention on the role of community-based workers in South Africa’s health system. This type of health worker is critical to the success of TB and HIV programmes.

In his recent budget vote speech, Health Minister Aaron Motsoaledi said that as of January next year antiretrovirals (ARVs) are to be rolled out earlier– at a CD4 count of 500 (as opposed to 350). This means more people will be on treatment. Yet success in fighting HIV as well as TB does not stop at access to and availability of treatment. Additionally, people who start treatment must continue to take TB medication for at least six months, or in the case of ARVs, for the rest of their lives. With clinics overwhelmed by the need to diagnose and start patients on medication, the difficult task of keeping patients in care and walking the journey of treatment with them falls to a different cadre of health workers – community care workers.

Community care workers (CCWs) are tasked with supporting members of their community who are living with HIV and/or TB. They do so weekly and focus on giving adherence support (monitoring whether clients are taking their medication through counting pills), making referrals for social services, and screening other households members. Their function is especially important when there is insufficient social support in the home and a lack of knowledge about TB and HIV. With busy clinic health workers who may not speak the language of the patient, community care workers can become the main source of health information for a patient and a critical link to the health facility.

TB/HIV Care Association employs a total of 243 community care workers in the Western Cape, the majority of whom are women. Being a community care worker is not an easy job. Because these women must walk around the community visiting their patients, they are at risk. Many experience varying degrees of gender-based violence while doing their work. Like other health workers, CCWs are also at increased risk of contracting TB.

As an indispensable part of South Africa’s current and future health system, it is TB/HIV Care’s position that community-based workers should be acknowledged, properly supported and trained, and adequately compensated for their work.

In July, the National Department of Health announced a ‘revitalization’ of the national HIV counselling and testing (HCT) campaign that was held in 2010/11. The campaign, like the first, intends to make knowing your HIV status top of mind for the public, but this campaign has also refined its focus.

The initial, 2010/11 national HCT campaign aimed to test 15 million adult South Africans within the course of a year. About 13 million people were reached. TB/HIV Care has been running an HCT programme since 2007 and supported the campaign within clinics and hospitals through ‘facility-based’ lay counsellors, and in communities through mobile teams consisting of a professional nurse counsellor and 3 lay counsellors. Over the course of the 2010/11 campaign year, TB/HIV Care tested 282 339 people. Last year, this rose to 417 501.

The new, ‘revitalized’ campaign is different. The targets set for this year are focused on specific groups of people or populations. The campaign will aim to reach sexually active people, those who have not tested before or within a year, on young people in high schools and tertiary institutions, and on people living in densely-populated areas where HIV prevalence is high. The idea is to target efforts to achieve the greatest impact.

Another aspect of the new national HCT campaign is that it has expanded beyond HIV into a full wellness package that includes screening for TB, sexually-transmitted infections and non-communicable diseases like diabetes and hypertension, as well as promoting medical male circumcision and other methods of HIV prevention.

TB/HIV Care is well-placed to roll out this expanded package of care, and to reach the target populations. Each mobile team is equipped to test for HIV, to screen for TB, STIs, diabetes, hypertension and to measure body-mass-index. With mobile teams, TB/HIV Care is also well-suited to seek out the populations being targeted as these groups might not regularly visit health facilities.

TB/HIV Care Association will support the revitalized HCT campaign in all 10 districts in which the organization operates.

At two workshops held with the Department of Justice and Correctional Services (DJCS) in August, TB/HIV Care Association was able to report on several improvements in TB and HIV care in the Pollsmoor Management Area.

Any successes have been made possible by the close partnership between the stakeholders involved in providing TB and HIV care in correctional services. Many of these partners were present at the workshops which took place in the Western and Eastern Cape and included the National and Regional Department of Justice and Correctional Services (DJCS), who hosted the workshops, the Departments of Health (DOH) (Western and Eastern Cape), the Hospice Palliative Care Association, the National Health Laboratory Systems, Right to Care, SA Partners and Sonke Gender Justice.

The aim of the workshops was to solidify these partnerships and chart a way forward. The objectives therefore included informing all participants of donor-funded project activities in TB and HIV care, working on operational plans to strengthen TB and HIV health care service provision in correctional services settings and the clarification of the roles and responsibilities of all the stakeholders.

Formal presentations were done by the heads of the DOH and DJCS from national and provincial levels and thereafter breakaway group discussions took place around several focus areas. Each group created plans on how to address challenges within their area of expertise and team members were identified to take the lead in the implementation of these plans.

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